Risk factors of local recurrence of colorectal cancer: a multivariate study.

BACKGROUND/AIMS: Duke's staging is still the most widely used parameter in the estimation of risk for local recurrence in patients with colorectal neoplasia. The aim of this study is to identify biological determinants that may be of use in segregating patients with similarly staged tumors into groups with different risk of local recurrence. METHODOLOGY: Ninety-eight patients who had undergone curative resection for colorectal cancer between 1989 and 1991 were prospectively studied. Statistical analysis of clinical and pathologic variables was carried out using a Cox multivariate proportional hazard model. RESULTS: Dukes stage and DNA ploidy were the only significantly predictive variables for local recurrence. In particular, the factors increasing local recurrence risk were seen to be the presence of lymph node metastases and aneuploid status. In the absence of both of these negative prognostic factors the risk of local recurrence is practically nil, in the presence of just one it reaches 16% and in the presence of both it rises to over 40%. CONCLUSIONS: The results of this study indicate that the presence of an aneuploid tumor with positive lymph nodes places patients at a higher risk of local recurrence, and calls for post-operative adjuvant therapy and intensive follow-up.

[Prospective randomized comparative study of laparoscopic hernioplasty and Lichtenstein tension-free hernioplasty]. / Confronto prospettico randomizzato tra ernioplastica laparoscopica ed ernioplastica tension-free secondo Lichtenstein.

To compare the laparoscopic transabdominal preperitoneal inguinal hernioplasty (TAPP) and the open Lichtenstein technique, in 1992 a prospective randomized trial was initiated. Until 1995 108 patients with 130 hernias took part in the trial: 64 TAPP (group A) and 66 Lichtenstein (group B). 22 patients had simultaneous bilateral repairs. Laparoscopic approach (group A) was able to expose otherwise-occult controlateral hernias in 3 cases and discovered a complex hernia (a hernia with more than one defect in the wall) in 2 patient in whom a direct hernia had been diagnosed before the operation. Mean operating time for monolateral operations was significantly longer in group A (p < 0.05). The corresponding figures for bilateral operations were longer in group B (p < 0.01). No intraoperative complications, conversions from TAPP to open repair, postoperative deaths. There were not less pain quicker mobility and shorter period of disability in the laparoscopic group (group A). Ten (15.6%) postoperative complications occurred in group A: local hematoma (6 cases, 9.3%), neuralgias (3 cases, 4.7%), urinary retention (1 case, 1.6%). Eight (12.1%) postoperative complications: hematomas (3 cases, 4.5%), urinary retention (3 cases, 4.5%), neuralgias (2 cases, 3%) occurred in group B. Differences were not significant. The current follow-up period is 36 months (15-54) in median. In both groups no recurrences occurred, but 3 patients in group B who were operated on for monolateral hernia (6.5%) discovered to be affected by contralateral hernia. The results of the present report suggest that TAPP does not appear to be associated with better results in terms of complications, pain or period of disability as compared to open tension free hernia repair, but the ability of the laparoscopic approach to expose otherwise-occult defects eliminated the risk of recurrences due to missed hernias.

[Extended resection in colorectal cancer. Personal experience]. / La resezione allargata per cancro del colon-retto. Esperienza personale.

At the moment of surgical intervention, colorectal cancer involves adjacent tissues or organs in a percentage of cases ranging between 5% and 12%. "En bloc" resection of these tumors, when not associated with distant metastasis, allows survival at 5 years in from 32% to 79% of cases. The authors discuss their personal experience on the subject of extended resection for carcinoma of the large intestine, in order to evaluate not only the possible anatomico-clinical peculiarities but also both short and long term results. In the period from 1976 to 1993 1164 patients underwent surgery for colorectal cancer, in 791 cases (68%) with a curative aim. 71 patients underwent extended resection, in 59 cases for the curative treatment of a primary tumor and in 12 for the treatment of a local recurrence (LR). Pathologic examination revealed neoplastic infiltration into at least one of the organs removed with the tumor in 43 cases (61%). It must, however, be pointed out that the above frequency was considerably higher (92%) when extended resection was carried out for LR than in cases of exeresis of primary cancers (54%). The reported results show that extended resection leads to potentially higher morbidity and mortality than can be observed after standard resection, but that, at the same time, it proves to be the only treatment able to provide these patients with good prospects for fairly long-term survival. Recourse to this procedure must therefore always be out of necessity, furthermore the extension of demolition must be adapted to the operative finding.(ABSTRACT TRUNCATED AT 250 WORDS)